2010년 한국인 뇌졸중의 경제적 질병부담 - KoreaMed · 2012-12-21 · service provider instead of the value of Korea Health Panel because of small proportion of using

1226 2010년 한국인 뇌졸중의 경제적 질병부담

Healthcare Policy

c Korean Medical AssociationThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

J Korean Med Assoc 2012 December; 55(12): 1226-1236http://dx.doi.org/10.5124/jkma.2012.55.12.1226pISSN: 1975-8456 eISSN: 2093-5951http://jkma.org

J Korean Med Assoc 2012 December; 55(12): 1226-1236

2010년 한국인 뇌졸중의 경제적 질병부담김 현 진

1·김 영 애

1·서 혜 영

2·김 은 정

3·윤 석 준

4·오 인 환

5* | 고려대학교

1일반대학원 보건학협동과정,

2보건대학원 보건 정

책 및 병원관리학과, 3제주한라대학교 간호학과,

4고려대학교 의과대학 예방의학교실,

5경희대학교 의학전문대학원 예방의학교실

The economic burden of stroke in 2010 in Korea Hyun-Jin Kim, MPH1

·Young-Ae Kim, MPH1·Hye-Young Seo2

·Eun-Jung Kim, PhD3·Seok-Jun Yoon, MD4

·In-Hwan Oh, MD5*

1Department of Public Health, Graduate School, 2Department of Health Policy and Hospital Management, Graduate School of Public Health, Korea University, Seoul, 3Department of Nursing, Cheju Halla College, Jeju, 4Department of Preventive Medicine, College of Medicine, Korea University, Seoul, 5Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea

*Corresponding author: In-Hwan Oh, E-mail: [email protected]

Received October 4, 2012·Accepted October 25, 2012

Introduction

Stroke is a major cause of death in developed coun-

tries, including the US and Europe [1,2]. In Korea,

stroke rates are expected to increase due to the aging of

population. According to the mortality data of the

Korean Statistical Information Service in 2010, the

second leading cause of death by disease group in

Korea is cardiovascular diseases, followed cancer.

Stroke, which is one of the most common cardiovas-

cular diseases, is currently the number one cause of

death attributed to a single organ disease [3]. In addi-

Stroke is a disease that causes a substantial economic burden. With the rapidly aging population in Korea, the prevalence of chronic diseases, including stroke, is expected to rise, along with

associated health care expenditures. Therefore, we estimated the economic burden of stroke in Korea in 2010 using nationally representative data. We used a prevalence-based approach to estimate the cost of stroke by claims data from the Korean National Health Insurance. Data from the Korea Health Panel, the Korea National Statistical Office’s records of causes of death, and Labor Statistics were used to calculate direct non-medical costs and indirect costs. Direct costs included direct medical costs and direct non-medical costs, and indirect costs were opportunity costs lost due to premature death and productivity loss. Total costs were estimated by adding age- and gender-specific costs. The total economic burden of stroke was $3.53 billion: $1.87 billion for hemorrhagic stroke and $1.66 billion for ischemic stroke. The direct costs were $1.74 billion and the indirect costs were $1.79 billion. By gender, males were burdened at $2.19 billion, while females bore $1.34 billion of the total burden. Stroke imposes a huge economic burden, as indicated by the fact that the costs of stroke increased by 4.4% from 2005 to 2010, and the estimated cost was 0.35% of gross domestic product. Therefore, effective prevention programs and treatments are needed to reduce the economic burden of stroke in Korea.

Keywords: Stroke; Cost of illness; Economic burden; Prevention & control

1226_12월_의료정책_김현진_1210.indd 1226 12. 12. 14. 오후 8:18

의료정책The economic burden of stroke in 2010 in Korea

대한의사협회지 1227J Korean Med Assoc 2012 December; 55(12): 1226-1236

tion, according to the Korean National Health and Nutri-

tional Examination Survey (KNHANES), although the

stroke mortality rate decreased by 12.1% from 2005 to

2008, the prevalence of stroke in people over the age of

30 increased by 0.4% [4].

In addition, elderly people (those over 65 years old)

comprised 10.6% of the Korean population in 2010,

and by 2019 that proportion is expected to increase to

14.4%. This demographic transition is likely to become

even more significant as life expectancy increases [5].

This supports the theory that stroke will remain one of

most important diseases in terms of Korea’s overall

disease burden.

Stroke is known to contribute to high mortality rates

and socioeconomic costs. For example, a British study

using a prevalence-based approach estimated the costs

associated with stroke at $13 billion, while a one-year

study using an incidence-based approach reported that

stroke-related costs equaled $65.5 billion in 2008 in the

US [1,6]. Previous studies have estimated the cost of

stroke in Korea. One study using an incidence-based

approach calculated the lifetime cost per person, and

found that the cost for a Korean man was expected to

be $167,250 with an age of onset of 45 [7]. Another

study by Lim et al. estimated the economic burden of

stroke in 2005 using a prevalence-based approach [8].

However, this study did not assess the overall costs of

stroke. For example, it excluded the cost of assistive

devices integral to rehabilitation. Studies conducted in

developed countries have typically included the cost of

assistive devices in the estimation of overall costs

[1,2,8,9]. Because stroke is often accompanied by

disabilities that impede the activities of daily living, the

costs for rehabilitation, such as assistive devices, should

be considered when measuring the economic burden

of stroke [1]. For example, in a Canadian study, the cost

of assistive devices was 0.3% of the direct medical costs

of stroke, which was equal to the cost of prescription

drugs and professional fees [10]. A Swedish study that

assessed the cost of assistive devices during the first

year after acute stroke showed that $646 was spent per

patient [11]. In order to manage stroke patients more

efficiently, a more accurate estimate of Korean stroke-

related costs is needed.

The objective of this study was to estimate the eco-

nomic burden of stroke during 2010 using data from

the National Health Insurance Corporation (NHIC). We

also examined the components of stroke-related costs

in Korea, using the most up-to-date nationally repre-

sentative data available.

Methods

In this study, we calculated the cost of stroke using a

prevalence-based approach. Stroke was defined as

I60-I63 according to the International Classification of

Disease 10th version, and stroke cases were classified

into two subtypes: hemorrhagic stroke (codes I60-I62)

and ischemic stroke (code I63) [12]. To increase the

accuracy of the case definitions, stroke patients were

defined as those with a primary diagnosis of stroke

who had at least one inpatient or three outpatient

claims for visiting or hospitalization in a medical

institution during 2010 [2]. All costs measured were

converted into US dollars using an exchange rate of

1,176 Korean won to US $1 (2010 exchange rate) [13].

The economic costs of stroke were divided into direct

and indirect costs. Direct costs were direct medical care

costs, including non-NHIC-covered care costs, medical

services, costs of meals, and elective services, as well as

prescription and assistive device costs. Direct non-

medical costs consisted of transportation costs and

1226_12월_의료정책_김현진_1210.indd 1227 12. 12. 14. 오후 8:18


Kim HJ et al


caregiver costs [1,2,9].

In order to assess direct medical costs, we used claims

data from the NHIC in 2010. In Korea, the NHIC is the

exclusive health insurer. Thus, the NHIC claims data are

representative of medical expenses from the Korean

insurance program [14]. Prescription costs were defined

as the calculated costs of drugs prescribed to stroke

outpatients during 2010 based on NHIC claims data.

In order to assess non-NHIC-covered care costs, data

on the proportion of non-NHIC covered cost were

gathered. The non-NHIC covered cost rates of stroke

patients were applied in our analysis (inpatient: 16.8%

for hemorrhagic stroke and 13.9% for ischemic stroke;

outpatient stroke: 16.6%) [15].

Additionally, to collect information on assistive devices

costs, a survey of 83 patients was conducted at three

rehabilitation hospitals by authors (Department of

Rehabilitation Medicine, Konkuk University Medical Cen-

ter, of Yeogang Rehabilitation Center, and of Bucheon

Daesung Rehabilitation Hospital). This group was

composed of patients in both acute and chronic stages of

stroke. The survey determined the annual average cost of

assistive devices to be $205.40 per person. This amount

was then multiplied by the number of stroke patients.

In order to calculate direct non-medical costs, the

average two-way transportation cost per hospital visit

was calculated based on data obtained from the Korean

Health Panel in 2008 [14]. The average one-way trans-

portation cost per inpatient visit for stroke was $6.83,

which covered the transportation costs of the patient and

a caregiver. The cost of one-way transportation per

outpatient visit was calculated to be $0.70 [16].

For inpatient visits, caregiver costs were calculated by

multiplying the number of days of hospitalization by the

average caregiver cost per day ($51.00 in 2005). We

used the cost established by a representative nursing

service provider instead of the value of Korea Health

Panel because of small proportion of using the paid care

giver in Korea Health Panel [17]. Also to estimate the

cost of family or other voluntary caregiver, the average

wage of paid caregiver is used as a proxy for the cost of

caregiving, because the difference of task in caregiving

between paid and unpaid caregiver is unknown [18]. In

order to convert the caregiver rate to 2010 prices, the

price index of 116 was adjusted, comparing with the

price index of 2005. In order to calculate caregiver costs

for outpatient visits, it was assumed that patients

younger than nine years of age and older than 60 would

require a caregiver. The average daily wage for a

caregiver in 2005 was multiplied by the total number of

outpatient visits and then adjusted to reflect the 2010

price index. It was assumed that each outpatient visit

would require approximately 1/3 of the patient’s daily

working hours [14]. Visit duration was then multiplied

by the number of outpatient visits.

Indirect costs were defined as the opportunity costs

lost due to the use of medical services or premature

death, and were estimated by calculating the total

productivity loss based on the human capital approach

[19]. Productivity loss for inpatients was determined by

calculating the average monthly working hours and the

average monthly wage as detailed by a survey report

on labor conditions in 2007 [20]. Because patients

under 19 and over 70 years of age were not considered

to be of working age, only the productivity losses for

patients between the ages of 20 and 69 were

considered. In order to estimate average monthly work

losses due to outpatient visits, the average visit duration

was multiplied by the number of outpatient visits.

Productivity loss resulting from premature death was

calculated based on the number of deaths from stroke

reported in the cause of death statistics [3]. Potential

1226_12월_의료정책_김현진_1210.indd 1228 12. 12. 14. 오후 8:18



incomes of the age groups were converted into present

values by an annual discount rate of 5% [21].

To complete the sensitivity analysis, two methods

were employed: varying the discount rates for the cost of

mortality and varying outpatient case definitions for

stroke. The cost of premature death was recalculated

using the annual discount rates of 0% and 3%, instead of

5%. Second, a cost estimation using three different out-

patient case definitions, including having one or two out-

patient claims and the present criteria, was conducted.

Results

In 2010, the total number of treated cases of stroke

was 396,843, the number of cases of ischemic stroke

was 332,523, and the number of cases of hemorrhagic

stroke was 64,319. There were no significant differ-

ences in the number of treated cases according to gen-

der: 203,847 were males and 192,996 were females.

The total economic cost of stroke was $3.53 billion:

$1.87 billion for hemorrhagic stroke and $1.66 billion

for ischemic stroke (Table 1). Direct costs were esti-

mated to be approximately 49% of this total, with indi-

rect costs counting for the remaining 51%. In the analy-

sis of direct costs, direct medical care costs were $1.15

billion and direct non-medical costs were $584 million,

which was 50% of the total direct medical care costs. In

the breakdown of indirect costs, costs due to premature

death were $1.39 billion and costs due to lost producti-

vity were $406 million. The total indirect costs were esti-

mated to be $1.79 billion.

By gender, males accounted for $2.19 billion of the

Table 1. Direct and indirect economic burden of stroke in Korea

Age of patients

(yr)

Direct costs Indirect costs

Total costsb)

Direct medical care costsDirect non-

medical care costs

Total direct costs

Lost pro-

ductivity

Cost of pre-mature deathPaid by

insurer

Copay-ment by patients

Non-covered services

costs

Prescribed pharma-ceutical costs

Assis-tive de-vices costs

Total direct

medical care

costsa)

Trans-por-

tation costs

Caregiver costs

Male

Total 364.23 87.18 65.37 0.01 40.45 557.35 4.53 265.47 827.34 311.22 1,047.23 2,185.79

0-19 1.62 0.27 0.32 0.00 0.12 2.32 0.01 0.56 2.90 0.00 5.08 7.97

20-69 237.26 51.24 43.41 0.01 24.40 356.38 2.79 162.34 521.50 311.22 1,042.15 1,874.88

≥70 125.35 35.68 21.64 0.01 15.94 198.65 1.73 102.57 302.94 0.00 0.00 302.94

Female

Total 386.85 93.77 69.06 0.01 44.53 594.29 4.68 309.65 908.61 95.10 338.39 1,342.10

0-19 1.07 0.21 0.21 0.00 0.08 1.57 0.01 0.45 2.03 0.00 2.31 4.34

20-69 151.81 33.44 28.38 0.01 13.87 227.53 1.72 95.57 324.82 95.10 336.08 756.00

≥70 233.98 60.12 40.47 0.00 30.58 365.19 2.95 213.63 581.77 0.00 0.00 581.77

Total 751.08 180.95 134.43 0.03 84.98 1,151.63 9.21 575.11 1,735.95 406.33 1,385.62 3,527.89

Expressed as $US million.a) Sum of costs paid by insurer + copayment by patients + non-covered services + prescribed pharmaceuticals + assistive devices.b) Sum of direct costs + indirect costs.

1226_12월_의료정책_김현진_1210.indd 1229 12. 12. 14. 오후 8:18


Kim HJ et al


total cost, compared to a total cost of $1.34 billion for

females. By age group, the economic burden of male

patients ($1.88 billion) aged between 20 and 69 was

higher than that of females ($760.34 million), whereas

female patients ($581.77 million) over the age of 70

accounted for approximately 1.9 times the costs of males

in the same age group ($302.94 million).

Comparing the costs of hemorrhagic stroke with

ischemic stroke, the cost of hemorrhagic stroke was

approximately 1.13 times higher than ischemic stroke.

For hemorrhagic and ischemic stroke, the direct costs

were $600.61 million and $1.14 billion, respectively,

while the indirect costs were $1.27 billion and $520.46

million, respectively. For the hemorrhagic stroke costs,

the indirect costs were more than twice as high as the

direct costs, while the direct costs of ischemic stroke

were 2.16 times more than the indirect costs.

By age group, cost of premature death for hemor-

rhagic stroke was the highest burden aged 20 to 69

($1.09 billion), ischemic stroke was similar result both

the cost of premature death and direct medical costs

($287.72 million, $284.43 million). The direct costs

over the age of 70 were $188.62 million for hemor-

rhagic stroke, $696.08 million for ischemic stroke and

the cost of ischemic stroke was 3.7 times more than

that of hemorrhagic stroke (Tables 2,3).

In the sensitivity analysis of the discount rate, the

cost of premature death ranged from $1.39 billion to

$2.20 billion. Indirect costs ranged from $1.79 billion to

$2.61 billion. Consequently, the total economic burden

of stroke ranged from $3.53 billion to $4.34 billion. This

is between 5.2% and 6.4% of the total cost of health

Table 2. Direct and indirect economic burden of hemorrhagic stroke in Korea

Age of patients

(yr)


Total costsb)


medical care costs

Total direct costs

Lost pro-

ductivity


insurer



costs


Assis-tive de-

vices costs

Total direct

medical care

costsa)

Trans-por-

tation costs

Caregiver costs

Male

Total 147.47 25.71 29.77 0.01 12.24 215.21 1.07 82.00 298.28 128.96 816.07 1,243.31

0-19 1.36 0.20 0.27 0.00 0.08 1.90 0.01 0.42 2.33 0.00 4.88 7.22

20-69 117.26 19.10 23.67 0.00 9.36 169.40 0.84 63.82 234.05 128.96 811.18 1,174.20

≥70 28.85 6.42 5.82 0.00 2.81 43.90 0.23 17.76 61.89 0.00 0.00 61.89

Female

Total 149.86 27.16 30.25 0.01 11.92 219.22 1.04 82.07 302.32 44.82 281.63 628.78

0-19 0.85 0.14 0.17 0.00 0.06 1.22 0.01 0.33 1.56 0.00 2.31 3.86

20-69 90.33 15.29 18.23 0.00 6.23 130.08 0.59 43.36 174.03 44.82 279.32 498.18

≥70 58.69 11.73 11.85 0.00 5.64 87.91 0.44 38.38 126.73 0.00 0.00 126.73

Total 297.33 52.87 60.02 0.01 24.16 434.42 2.11 164.07 600.61 173.78 1,097.70 1,872.09


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care in 2010 ($68 billion) [5]. A sensitivity analysis of

outpatient case definitions was also performed. The esti-

mated total cost for one outpatient claim was $3.86 bil-

lion, which was increased than three outpatient claims

by 9.3%. The cost of outpatient case ranged from $71.80

million (present criteria) to $357.47 million (one outpa-

tient claim) (Tables 4,5).

Discussion

This study estimated the economic burden of stroke

using data sources such as the NHIC and survey data.

In 2010, 396,843 patients in Korea were diagnosed and

treated in stroke. The total cost of stroke was estimated

to be $3.53 billion: $1.87 billion for hemorrhagic stroke

and $1.66 billion for ischemic stroke. The estimated

cost of stroke was 0.35% of the Korean gross domestic

product (GDP) and 5% of national health care expendi-

tures [5].

By cost item, total direct medical costs were $1.15

billion, total non-medical costs were $584 million, and

indirect costs were $1.79 billion. Direct costs were

2.6% of the total cost of health care in 2010, and were

1.2 times larger than the costs of lung cancer ($1.41

Table 4. Sensitivity analysis for various discount rates

Cost category Discounted at 0%

Discounted at 3%

Discounted at 5%

Lost productivity 406 406 406

Cost of premature death

2,201 1,630 1,386

Indirect cost 2,607 2,036 1,792

Total cost a) 4,343 3,773 3,527

Expressed as $US million.a) Sum of direct costs + indirect costs.

Table 3. Direct and indirect economic burden of ischemic stroke in Korea

Age of patients

(yr)


Total costsb)


medical care costs

Total direct costs

Lost pro-

ductivity


insurer



costs


Assis-tive de-vices costs

Total direct

medical care

costsa)

Trans-por-

tation costs

Caregiver costs

Male

Total 216.77 61.47 35.60 0.01 28.21 342.14 3.45 183.47 529.06 182.26 231.16 942.48

0-19 0.26 0.07 0.04 0.00 0.04 0.42 0.01 0.14 0.56 0.00 0.20 0.76

20-69 120.00 32.14 19.74 0.00 15.04 186.98 1.95 98.52 287.45 182.26 230.96 700.68

≥70 96.50 29.26 15.81 0.00 13.14 154.74 1.50 84.81 241.05 0.00 0.00 241.05

Female

Total 236.99 66.61 38.81 0.01 32.61 375.07 3.64 227.58 606.29 50.28 56.76 713.32

0-19 0.22 0.07 0.04 0.00 0.02 0.35 0.00 0.12 0.47 0.00 0.00 0.47

20-69 61.48 18.15 10.15 0.00 7.65 97.45 1.12 52.21 150.78 50.28 56.76 257.82

≥70 175.29 48.39 28.62 0.00 24.94 277.28 2.51 175.25 455.03 0.00 0.00 455.03

Total 453.75 128.08 74.41 0.01 60.82 717.21 7.09 411.05 1,135.35 232.54 287.92 1,655.81


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Kim HJ et al


billion) in 2005 [22]. Also the proportion of 0.35% is

lower than all musculoskeletal diseases (0.7% of GDP

in 2008) or all cancer (1.75% of GDP in 2005), but is a

substantial burden in Korea [14,22]. In the sensitivity

analysis, the rate of increase of the total economic bur-

den of stroke ranged from 6.9% to 23.13%, as seen

when applying the different discount rates and outpa-

tient case definitions.

In 2005, the economic burden of stroke in Korea was

estimated as $3.38 billion, of which medical costs were

$1.02 billion, which was approximately 7.8% of national

health care expenditures and 0.46% of the GDP in Korea

that year [8]. In this study, there was a difference in

stroke-related costs between 2005 and 2010, and a cost

increase of almost $0.15 billion from 2005 to 2010.

This distinction may be the burden of rising direct

medical costs due in part to the development of new

diagnostic equipment, the increased use of more expen-

sive equipment and inflation of prices [8]. However,

methodological differences could also be partly res-

ponsible. First, Lim et al. [8] included transient ischemic

attacks (TIA, G45) patients with the stroke patients

classified as I60-I69, and defined

them as adult patients over age 20

who have claimed stroke as the

primary or secondary diagnosis.

However, in this study, we defined

stroke patients who had at least one

inpatient or three outpatient claims

as I60-I63, and patients with TIA

were excluded. In addition, we

estimated the costs of entire age

groups with stroke as the primary

disease. Second, in the study by Lim

et al. [8], the cost of assistive devices

was excluded due to the difficulty

involved in quantification. In contrast, our study

included the cost of assistive devices. Considering that

non-covered care represented 3% to 4% of the total

costs, the cost of assistive devices is an also important

part of the overall economic burden of stroke. Last, the

results of the KNHANES for transportation were applied

in the estimation of direct non-medical costs, and

transportation costs were estimated to be 0.7% of the

total direct costs. However, because we hypothesized

that patients who suffer from chronic diseases such as

stroke would rarely travel to another region to receive

treatment, we estimated the cost of stroke-specific

transportation from Korea Health Panel data. Therefore,

the transportation costs were assessed as 0.5% of the

total direct costs, which is lower than that used by Lim et

al. [8].

In 2010, direct costs were 49% and indirect costs

were 51% of the total costs, compared to 2005 where

the direct costs were 31% and indirect costs were 69%

of the total costs [8]. Our results showed a trend similar

to that seen in many other studies. In studies done in

other countries, direct costs have been shown to be

Table 5. Sensitivity analysis using various outpatient case definitions

Cost component Three or more visits (present criteria) Two or more visits One or more visits

Direct medical cost

Inpatient care 1,079.83 (30.61) 1,079.83 (28.18) 1,079.83 (27.98)

Outpatient care 71.80 (2.04) 335.07 (8.75) 357.47 (9.26)

Direct non-medical cost

Caregiver cost 575.11 (16.30) 577.64 (15.08) 580.57 (15.04)

Transportation 9.21 (0.26) 9.39 (0.24) 9.45 (0.24)

Indirect cost

Lost productivity 406.33 (11.52) 443.70 (11.58) 446.37 (11.57)

Cost of premature death

1,385.62 (39.28) 1,385.62 (36.17) 1,385.62 (35.90)

Total cost a) 3,527.90 (100.00) 3,831.24 (100.00) 3,859.30 (100.00)

Expressed as $US million. Values are presented as cost (%).a) Sum of direct costs + indirect costs.

1226_12월_의료정책_김현진_1210.indd 1232 12. 12. 14. 오후 8:18



higher than indirect costs in spite of methodological

differences [1,2]. A study conducted in the UK (2004)

estimated direct costs to be $9.40 billion, of which

$6.15 billon (65%) were medical costs, $2.05 billion

(22%) were non-medical costs, and $1.07 billion (12%)

were costs due to productivity loss. In addition, in a

study conducted in the EU, direct costs (61.1%) were

found to be greater than indirect costs (38.9%) [1,2].

The results of the present study showed that the direct

costs associated with stroke increased from 2005 to

2010. Since stroke occurs primarily in people over the

age of 60, indirect costs caused by productivity loss and

premature death were relatively small in this age group,

as compared to those of young adults and middle-aged

people. Therefore, indirect costs are not a large part of

the overall economic burden of this disease compared

to direct costs.

The cost of hemorrhagic stroke was higher than the

cost of ischemic stroke according to disease group. In

addition, some differences in cost distribution were

observed. In the analysis of hemorrhagic stroke costs,

indirect costs (67.92%) were the highest, followed by

direct medical costs (23.20%) and direct non-medical

costs (8.87%). For ischemic stroke, direct medical costs

(43.41%) were the greatest burden, followed by

indirect costs (31.43%) and direct non-medical costs

(25.25%). According to age group, the estimated cost

for patients between the ages of 20 and 69 with

hemorrhagic stroke was higher than for those with

ischemic stroke: 89.33% vs. 57.88%, respectively.

Hemorrhagic stroke, which carried a heavier burden in

indirect costs, occurred in the younger age groups and

had a higher fatality rate, accounting for relatively

greater predicted life-time earnings foregone. For

ischemic stroke, the cost of health care use was high

due to the large prevalence of the disease.

Between the male and female patients, men had a

heavier economic burden of disease than women, and

a subsequently higher socio-economic cost. However,

females had higher total direct medical costs and direct

non-medical costs than did males. Males incurred higher

indirect costs compared to females. This is because

males typically experience stroke at an earlier age. On

the other hand, women had higher direct costs than

indirect costs and had higher overall medical costs due

to the gender differences in stroke. In a study of the

functional outcomes after stroke and the use of medical

resources, it was found that females experience stroke

later in life compared to males, and their number of

inpatient days was slightly longer [23]. Hence, their func-

tional outcome after the onset of stroke is worse than

that seen in males. Females also have a higher risk of

developing severe disability, resulting in subsequently

higher direct medical costs. Studies in Europe, Canada,

and Korea have shown similar findings [23-26]. There-

fore, intervention strategies which take into account

gender differences in stroke outcome should be con-

sidered.

When we compare the results according to age

group, the economic burden of stroke in patients over

the age of 60 accounted for 49.45% of the total cost

(data not shown). This phenomenon is associated with

the high prevalence of stroke after the age of 65. In a

study of the relationship between stroke and TIA

prevalence in the elderly Korea population, the

prevalence of stroke increased until the ages of 75 and

79, but decreased thereafter [27]. In addition, institu-

tionalization costs incurred by elderly patients who

suffer an incapacitating stroke will most likely increase,

and ultimately the social costs will increase as well [28].

Therefore, Korea requires a health care policy to man-

age stroke that matches the needs of our rapidly aging

1226_12월_의료정책_김현진_1210.indd 1233 12. 12. 14. 오후 8:18


Kim HJ et al


society.

This study has several limitations. First, we were not

considered the cost of disability after stroke. There was

no disability data in Korea National Health Insurance

Claims Database, such as the modified Rankin Scale

(mRS). Especially, the mRS was important to expect the

extent of disability in stroke survivors and the estimation

of rehabilitation cost due to disability was necessary after

stroke [29]. Thus, the economic burden of stroke may

have been underestimated. Second, we were unable to

estimate the costs of house repairs, health supplement

food, herbal medicine, and long-term use of a nursing

facility due to limitations in the data. The economic

burden could be even heavier when these costs were

included. Third, it has been reported that 15.7% of

stroke patients use over-the-counter (OTC) products for

the prevention of secondary complications, which

should be included in drug-related costs. However,

because a large number of aspirin-type OTC products

are also used to prevent hypertension and cardio-

cerebrovascular diseases, the costs of these types of

drugs were excluded from this study to avoid overesti-

mation [30]. Fourth, there may have been validity pro-

blem of survey sampling in the cost of assistive devices,

and there is a possibility of overestimation of stroke

burden. Finally, because it was difficult to quantify the

deterioration in quality of life resulting from social and

environmental changes, such as psychological pain and

anxiety, these factors were excluded from the cost

analysis. If these costs were considered, the economic

burden due to stroke could be even higher.

Conclusion

In this study, the economic burden of stroke was

estimated using current nationally representative data

and was determined to be in $3.53 billion in costs, the

equivalent of 0.35% of the GDP. The economic burden

of stroke has increased by 4.4% from 2005 to 2010.

With the Korean society increasingly aging, the econo-

mic burden of stroke will continue to be substantial

into the future. Therefore, we must endeavor to reduce

the economic burden of stroke in Korea and the more

accurate estimation of economic burden would help

this goal.

Acknowledgement

This research was supported by the Basic Science

Research Program through the National Research Foun-

dation of Korea funded by the Ministry of Education,

Science and Technology (20120001612).

핵심용어: 뇌졸증; 질병비용; 경제적 질병부담; 예방과 관리

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Kim HJ et al


뇌졸중은 우리나라 사망원인 중 2위를 차지하는 심혈관계 질환의 가장 흔한 상병이며, 단일기관에 발생하는 사망원인 중

1위임에도 불구하고, 질병부담과 같은 경제적 손실에 대한 실증적 자료가 없었다. 이에 본 연구는 우리나라의 뇌졸중으로 인

한 총 질병부담액이 4조 1,488억원이며, 출혈성 뇌졸중은 2조 2,016억원, 뇌경색 뇌졸중은 1조 9,472억원에 달한다고 보고하

고 있어 의미 있는 연구라고 판단된다. 우리나라에서 뇌졸중으로 인한 총 질병부담액의 크기는 우리나라 GDP(2010년 기준)

0.35%에 해당하며, 향후 인구고령화에 급속한 진행과 함께 뇌졸중으로 인한 질병부담액의 지속적 증가가 의료비 증가의 주

요원인으로 대두될 것으로 예상할 수 있다는 점에서 주목할 필요가 있다.

[정리: 편집위원회]

Peer Reviewers’ Commentary

1226_12월_의료정책_김현진_1210.indd 1236 12. 12. 14. 오후 8:18

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